Pathophysiology of pediatric obstructive sleep apnea

Proceedings of the American Thoracic Society

Volumn 5, Issue 2, 2008, Pages 253-262

  Katz, Eliot S ^a   D'Ambrosio, Carolyn M ^b  

^a BOSTON CHILDREN S HOSPITAL   (United States)

^b TUFTS UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

Children; Sleep disordered breathing

Indexed keywords

AIRWAY OBSTRUCTION; AROUSAL; BREATHING MUSCLE; BREATHING PATTERN; CHILD; CRANIOFACIAL DEVELOPMENT; HUMAN; OBESITY; PATHOPHYSIOLOGY; PEDIATRICS; PHARYNX; REM SLEEP; REVIEW; SLEEP APNEA SYNDROME; SNORING; TACHYPNEA; UPPER AIRWAY RESISTANCE SYNDROME; UPPER RESPIRATORY TRACT;

CHILD; CRANIOFACIAL ABNORMALITIES; ELECTROMYOGRAPHY; HUMANS; OBESITY; PHARYNX; RISK FACTORS; SLEEP APNEA, OBSTRUCTIVE; SNORING;

EID: 39049139751     PISSN: 15463222     EISSN: None     Source Type: Journal    
DOI: 10.1513/pats.200707-111MG     Document Type: Review

References (86)

1. Arens R, Marcus CL. Pathophysiology of upper airway obstruction: a developmental perspective. Sleep 2004;27:997-1019.
2. Katz ES, Marcus CL. Obstructive sleep apnea: children versus adults. In: Pack AI, editor. Sleep apnea: pathogenesis, diagnosis, and treatment, 2nd ed. New York: Informa Healthcare; 2007. (In press).
3. Montgomery-Downs HE, O'Brien LM, Gulliver TE, Gozal D. Polysomnographic characteristics in normal preschool and early schoolaged children. Pediatrics 2006;117:741-753.
4. Uliel S, Tauman R, Greenfeld M, Sivan Y. Normal polysomnographic respiratory values in children and adolescents. Chest 2004;125:872-878.
5. Traeger N, Schultz B, Pollock AN, Mason T, Marcus CL, Arens R. Polysomnographic values in children 2-9 years old: additional data and review of the literature. Pediatr Pulmonol 2005;40:22-30.
6. Tabachnik E, Muller NL, Bryan AC, Levison H. Changes in ventilation and chest wall mechanics during sleep in normal adolescents. J Appl Phys 1981;51:557-564.
7. Verhulst SL, Schrauwen N, Haentjens D, Van Gaal L, De Backer WA, Desager KN. Reference values for sleep-related respiratory variables in asymptomatic European children and adolescents. Pediatr Pulmonol 2007;42:159-167.
8. Ali NJ, Pitson DJ, Stradling JR. Snoring, sleep disturbance and behavior in 4-5 year olds. Arch Dis Child 1993;68:360-366.
9. Gislason T, Benediktsdottir B. Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. Chest 1995;107:963-966.
10. Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children: associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med 1999;159:1527-1532.
11. Lopes MC, Guilleminault C. Chronic snoring and sleep in children: a demonstration of sleep disruption. Pediatrics 2006;118:e741-e746.
12. Guilleminault C, Li KK, Khramstov A, Palombini L, Pelayo R. Breathing patterns in prepubertal children with sleep-related breathing disorders. Arch Pediatr Adolesc Med 2004;158:153-161.
13. Rosen C, D'Andrea L, Haddad G. Adult criteria for obstructive sleep apnea do not identify children with serious obstruction. Am Rev Respir Dis 1992;146:1231-1234.
14. Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P. A cause of excessive daytime sleepiness: the upper airway resistance syndrome. Chest 1993;104:781-787.
15. Katz ES, Lutz JB, Black C, Marcus CL. Pulse transit time as a measure of arousal and respiratory effort in children with sleep-disordered breathing. Pediatr Res 2003;53:580-588.
16. Rizzi M, Onorato J, Andreoli A, Colombo S, Pecis M, Marchisio P, Morelli M, Principi N, Esposito S, Sergi M. Nasal resistances are useful in identifying children with severe obstructive sleep apnea before polysomnography. Int J Pediatr Otorhinolaryngol 2002;65:7-13.
17. Guilleminault C, Li K, Quo S, Inouye RN. A prospective study on the surgical outcomes of children with sleep-disordered breathing. Sleep 2004;27:95-100.
18. Tauman R, O'Brien LM, Holbrook CR, Gozal D. Sleep pressure score: a new index of sleep disruption in snoring children. Sleep 2004;27:274-278.
19. Goh DY, Galster P, Marcus CL. Sleep architecture and respiratory disturbances in children with obstructive sleep apnea. Am J Respir Crit Care Med 2000;162:682-686.
20. Chervin RD, Burns JW, Subotic NS, Roussi C, Thelen B, Ruzicka DL. Correlates of respiratory cycle-related EEG changes in children with sleep-disordered breathing. Sleep 2004;27:116-121.
21. Kheirandish-Gozal L, Miano S, Bruni O, Ferri R, Pagani J, Villa MP, Gozal D. Reduced NREM sleep instability in children with sleep disordered breathing. Sleep 2007;30:450-457.
22. Dayyat E, Maarafeya MMA, Capdevila OS, Kheirandish-Gozal L, Montgomery-Downs HE, Gozal D. Nocturnal body position in sleeping children with and without obstructive sleep apnea. Pediatr Pulmonol 2007;42:374-379.
23. Litman RS, Wake N, Chan LML, McDonough JM, Sin S, Mahboubi S, Arens R. Effect of lateral positioning on upper airway size and morphology in sedated children. Anesthesiology 2005;103:484-488.
24. Arai YCP, Fukunaga K, Ueda W, Hamada M, Ikenaga H, Fukushima K. The endoscopically measured effects of airway maneuvers and the lateral position on airway patency in anesthetized children with adenotonsillar hypertrophy. Anesth Analg 2005;100:949-952.
25. Brouillette RT, Manoukian JJ, Ducharme FM, Oudjhane K, Earle LG, Ladan S, Morielli A. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr 2001;138:838-844.
26. Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep 2004;27:761-766.
27. Guilleminault C, Huang Y, Glamann C, Li KK, Chan A. Adenotonsillectomy and obstructive sleep apnea in children: a prospective survey. Otolaryngol Head Neck Surg 2007;136:169-175.
28. Tauman R, Gulliver TE, Krishna J, Montgomery-Downs HE, O'Brien LM, Ivanenko A, Gozal D. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr 2006;149:803-808.
29. Monahan KJ, Larkin EK, Rosen CL, Graham G, Redline S. Utility of noninvasive pharyngometry in epidemiologic studies of childhood sleep-disordered breathing. Am J Respir Crit Care Med 2002;165:1499-1503.
30. Arens R, McDonough JM, Costarino AT, Mahboubi S, Tayag-Kier CE, Maislin G, Schwab RJ, Pack AI. Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2001;164:698-703.
31. Isono S, Shimada A, Utsugi M, Konno A, Nishino T. Comparison of static mechanical properties of the passive pharynx between normal children and children with sleep-disordered breathing. Am J Respir Crit Care Med 1998;157:1204-1212.
32. Kawashima S, Niikuni N, Chia-hung L, Takahasi Y, Kohno M, Nakajima I, Akasaka M, Sakata H, Akashi S. Cephalometric comparisons of craniofacial and upper airway structures in young children with obstructive sleep apnea syndrome. Ear Nose Throat J 2000;79:499-506.
33. Fregosi RF, Quan SF, Kaemingk KL, Morgan WJ, Goodwin JL, Cabrera R, Gmitro A. Sleep-disordered breathing, pharyngeal size and soft tissue anatomy in children. J Appl Phys 2003;95:2030-2038.
34. Donnelly LF, Surdulescu V, Chini BA, Casper KA, Poe SA, Amin RS. Upper airway motion depicted at cine MR imaging performed during sleep: comparison between young patients with and those without obstructive sleep apnea. Radiology 2003;227:239-245.
35. Lofstrand-Tidestrom B, Thilander B, Ahlqvist-Rastad J, Jakobsson OP, Hultcrantz E. Breathing obstruction in relation to craniofacial and dental arch morphology in 4-year-old children. Eur J Orthod 1999;21:323-332.
36. Behlfelt K, Linder-Aronson S, McWilliam J, Neander P, Laage-Hellman J. Cranio-facial morphology in children with and without enlarged tonsils. Eur J Orthod 1990;12:233-243.
37. Zettergren-Wijk L, Forsberg CM, Linder-Aronson S. Changes in dentofacial morphology after adeno-tonsillectomy in young children with obstructive sleep apnoea: a 5-year follow-up study. Eur J Orthod 2006;28:319-326.
38. Ozdemir H, Altin R, Sogut A, Cinar F, Mahmutyazicioglu K, Kart L, Uzun L, Davsanci H, Gundogdu S, Tomac N. Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients. Pediatr Radiol 2004;34:393-399.
39. Ronen O, Malhotra A, Pillar G. The influence of gender and age on upper airway length during development. Sleep 2007;30:A68.
40. Malhotra A, Huang Y, Fogel RB, Pillar G, Edwards JK, Kikinis R, Loring SH, White DP. The male predisposition to pharyngeal collapse: importance of airway length. Am J Respir Crit Care Med 2002;166:1388-1395.
41. Jeans WD, Fernando DCJ, Maw AR, Leighton BC. A longitudinal study of the growth of the nasopharynx and its contents in normal children. Br J Radiol 1981;54:117-121.
42. Arens R, Sin S, McDonough JM, Palmer JM, Dominguez T, Meyer H, Wootton DM, Pack AI. Changes in upper airway size during tidal breathing in children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2005;171:1298-1304.
43. Donnelly LF, Casper KA, Chen B. Correlation on cine MR imaging of size of adenoid and palatine tonsils with degree of upper airway motion in asymptomatic sedated children. AJR Am J Roentgenol 2002;179:503-508.
44. Arens R, McDonough JM, Corbin AM, Rubin NK, Carroll ME, Pack AI, Liu J, Udupa JK. Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2003;167:65-70.
45. Agren K, Nordlander B, Linder-Aronsson S, Zettergren-Wijk L, Svanborg E. Children with nocturnal upper airway obstruction: postoperative orthodontic and respiratory improvement. Acta Otolaryngol 1998;118:581-587.
46. Hultcrantz E, Larson M, Hellquist R, Ahlquist-Rastad J, Svanholm H, Jakobsson OP. The influence of tonsillar obstruction and tonsillectomy on facial growth and dental arch morphology. Int J Pediatr Otorhinolaryngol 1991;22:125-134.
47. Arens R, McDonough JM, Corbin AM, Hernadez ME, Maislin G, Schwab RJ, Pack AI. Linear dimensions of the upper airway structure during development: assessment by magnetic resonance imaging. Am J Respir Crit Care Med 2002;165:117-122.
48. Tasker C, Crosby JH, Stradling JR. Evidence of persistence of upper airway narrowing during sleep, 12 years after adenotonsillectomy. Arch Dis Child 2002;86:34-37.
49. Morton S, Rosen C, Larkin E, Tishler P, Aylor J, Redline S. Predictors of sleep-disordered breathing in children with a history of tonsillectomy and/or adenoidectomy. Sleep 2001;24:823-829.
50. Marcus CL, Curtis S, Koerner CB, Joffe A, Serwint JR, Loughlin GM. Evaluation of pulmonary function and polysomnography in obese children and adolescents. Pediatr Pulmonol 1996;21:176-183.
51. Silvestri JM, Weese-Meyer DE, Bass MT, Kenny AS, Hauptman SA, Pearsall SM. Polysomnography in obese children with a history of sleep-associated breathing disorders. Pediatr Pulmonol 1993;16:124-129.
52. Mitchell RB, Kelly J. Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children. Otolaryngol Head Neck Surg 2007;137:43-48.
53. Verhulst SL, Schrauwen N, Haentjens D, Suys B, Rooman RP, Gaal LV, De Backer WA, Desager KN. Sleep-disordered breathing in overweight and obese children and adolescents: prevalence, characteristics and the role of fat distribution. Arch Dis Child 2007;92:205-208.
54. De Vuono IM, Zanoteli E, de Oliveira AS, Fujita RR, Pignatari SSN, Pizarro GU, Pradelle-Hallinan ML, Moreira GA. Histological analysis of palatopharyngeal muscle from children with snoring and obstructive sleep apnea syndrome. Int J Pediatr Otorhinolaryngol 2007;71:283-290.
55. Huang J, Marcus C, Melendres C, Karamessinis L, Pepe M, Samuel J, Abi-Raad R, Trescher W, Colrain I. Respiratory sensation during sleep in children with obstructive sleep apnea syndrome [abstract]. Sleep 2007;30(Suppl):A67.
56. Goldbart AD, Goldman JL, Li RC, Brittian KR, Tauman R, Gozal D. Differential expression of cysteinyl leukotriene receptors 1 and 2 in tonsils of children with obstructive sleep apnea syndrome or recurrent infection. Chest 2004;126:13-18.
57. Goldbart AD, Goldman JL, Veling MC, Gozal D. Leukotriene modifier therapy for mild sleep-disordered breathing in children. Am J Respir Crit Care Med 2005;172:364-370.
58. Kheirandish L, Goldbart AD, Gozal D. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics 2006;117:e61-e66.
59. Wilson SL, Thatch BT, Brouillette RT, Abu-Osba YK. Upper airway patency in the human infant: influence of airway pressure and posture. J Appl Phys 1980;48:500-504.
60. Marcus CL, McColley SA, Carroll JL, Loughlin GM, Smith PL, Schwartz AR. Upper airway collapsibility in children with obstructive sleep apnea syndrome. J Appl Phys 1994;77:918-924.
61. Katz ES, Marcus CL, White DP. Influence of airway pressure on genioglossus activity during sleep in normal children. Am J Respir Crit Care Med 2006;173:902-909.
62. Marcus CL, Katz ES, Lutz J, Black CA, Galster P, Carson KA. Upper airway dynamic responses in children with the obstructive sleep apnea syndrome. Pediatr Res 2005;57:99-107.
63. Fregosi RF, Quan SF, Morgan WL, Goodwin JL, Cabrera R, Shareif I, Fridel KW, Bootzin RR. Pharyngeal critical closing pressure in children with mild sleep-disordered breathing. J Appl Physiol 2006;101:734-739.
64. Bandla P, Pepe M, Samuel J, Karamessinis L, Brooks LJ, Mason TA, Marcus CL. The effect of puberty on upper airway collapsibility [abstract]. Am J Respir Crit Care Med 2006;173:A734.
65. Marcus CL, Fernandes Do Prado LB, Lutz J, Katz ES, Black CA, Galster P, Carson KA. Developmental changes in upper airway dynamics. J Appl Phys 2004;97:98-108.
66. Marcus CL, Lutz J, Carroll JL, Bamford O. Arousal and ventilatory responses during sleep in children with obstructive sleep apnea. J Appl Phys 1998;84:1926-1936.
67. Marcus CL, Gozal D, Arens R, Basinski DJ, Omlin KJ, Keens TG, Ward SL. Ventilatory responses during wakefulness in children with obstructive sleep apnea. Am J Respir Crit Care Med 1994;149:715-721.
68. Katz ES, White DP. Genioglossus activity in children with obstructive sleep apnea during wakefulness and sleep onset. Am J Respir Crit Care Med 2003;168:664-670.
69. Gozal D, Burnside MM. Increased upper airway collapsibility in children with obstructive sleep apnea during wakefulness. Am J Respir Crit Care Med 2004;169:163-167.
70. Katz ES, White DP. Genioglossus activity during sleep in normal control subjects and children with obstructive sleep apnea. Am J Respir Crit Care Med 2004;170:553-560.
71. Henderson-Smart DJ, Read DJC. Reduced lung volume during behavioral active sleep in the newborn. J Appl Phys 1979;46:1081-1085.
72. Van de Graaff WB. Thoracic influence on upper airway patency. J Appl Phys 1988;65:2124-2131.
73. Stanchina ML, Malhotra A, Fogel RB, Trinder J, Edwards JK, Schory K, White DP. The influence of lung volume on pharyngeal mechanics, collapsibility, and genioglossus muscle activation during sleep. Sleep 2003;26:851-856.
74. Marcus CL, Moreira GA, Bamford O, Lutz J. Response to inspiratory resistive loading during sleep in normal children and children with obstructive apnea. J Appl Phys 1999;87:1448-1454.
75. Younes M. Role of arousals in the pathogenesis of obstructive sleep apnea. Am J Respir Crit Care Med 2004;169:623-633.
76. O'Brien LM, Mervis CB, Holbrook CR, Bruner JL, Klaus CJ, Rutherford J, Raffield TJ, Gozal D. Neurobehavioral implications of habitual snoring in children. Pediatrics 2004;114:44-49.
77. Moreira GA, Tufik S, Nery LE, Lutz J, Verfaille K, Luan X, Marcus CL. Acoustic arousal responses in children with obstructive sleep apnea. Pediatr Pulmonol 2005;40:300-305.
78. McNamara F, Issa F, Sullivan C. Arousal pattern following central and obstructive breathing abnormalities in infants and children. J Appl Physiol 1996;81:2651-2657.
79. 2 apneic threshold in newborn infants: possible relevance for periodic breathing and apnea. J Appl Phys 2005;98:1171-1176.
80. Waggener TB, Frantz ID, Cohlan BA, Stark AR. Mixed and obstructive apneas are related to ventilatory oscillations in premature infants. J Appl Phys 1989;66:2818-2826.
81. 2 as a potential treatment for apnea of prematurity. Semin Perinatol 2001;25:100-106.
82. Wellman A, Jordan AS, Malhotra A, Fogel RB, Katz ES, Schory K, Edwards JK, White DP. Ventilatory control and airway anatomy in obstructive sleep apnea. Am J Respir Crit Care Med 2004;170:1225-1232.
83. Poets CF, Rau GA, Neuber K, Gappa M, Seidenberg J. Determinants of lung volume in spontaneously breathing preterm infants. Am J Respir Crit Care Med 1997;155:649-653.
84. Fregosi RF, Quan SF, Jackson AC, Kaemingk KL, Morgan WJ, Goodwin JL, Reeder JC, Cabrera RK, Antonio E. Ventilatory drive and the apnea-hypopnea index in six-to-twelve year old children. BMC Pulm Med 2004;4:4.
85. Waters KA, McBrien F, Stewart P, Hinder M, Wharton S. Effects of OSA, inhalational anesthesia, and fentanyl on the airway and ventilation of children. J Appl Phys 2002;92:1987-1994.
86. Gozal D, Arens R, Omlin KJ, Ben-Ari G, Aljadeff G, Harper RM, Keens TG. Ventilatory response to consecutive short hypercapnic challenges in children with obstructive sleep apnea. J Appl Physiol 1995;79:1608-1614.